Engorgement 101: Reverse Pressure Softening Explained

What is Engorgement?

In the early days of breastfeeding, many parents experience engorgement — when breasts feel painfully full, swollen, or hard. Engorgement usually happens around day 3–5 after birth, when your milk “comes in” and blood and lymphatic fluid also build up in breast tissue.

Engorgement is common but can feel overwhelming: breasts may appear shiny or stretched, nipples flatten, and latching becomes more difficult. If not managed, it can lead to blocked ducts or even mastitis.

The good news? There are simple, evidence-based techniques that can bring relief and help your baby latch comfortably. One of the most effective is reverse pressure softening (RPS).

What is Reverse Pressure Softening (RPS)?

Reverse pressure softening is a gentle technique developed by lactation consultants to make latching easier during engorgement. It works by using firm, gentle pressure with your fingertips to move swelling away from the nipple and areola (the darker skin around your nipple).

By shifting fluid backwards into the breast tissue, RPS helps to:

• Soften the areola (making it easier for your baby to attach)

• Reduce nipple pain and stretching

• Improve milk flow in the early days of engorgement (Cotterman, 2004)

How to Do Reverse Pressure Softening

You can try RPS yourself or with the guidance of your midwife or IBCLC. Here’s a simple step-by-step:

1. Wash your hands

Always start with clean hands.

2. Position your fingers

• Place fingertips around the base of your nipple and areola.

• You can use two fingers on opposite sides (like a “scissor” hold), three fingers in a triangle, or all five fingertips encircling the nipple — whatever feels comfortable.

3. Apply gentle but firm pressure

• Press your fingertips directly back into your breast tissue (toward your chest wall).

• Hold the pressure for about 60 seconds.

4. Rotate and repeat

• Move your fingers around the nipple in small sections, repeating the pressure.

• Focus on softening just enough of the areola for your baby to latch deeply.

5. Try to feed or express immediately after

Once the areola is softened, offer the breast to your baby or express a little milk to maintain comfort.

When to Use RPS

Reverse pressure softening is especially helpful:

• In the first week, when milk volume rapidly increases

• When your breasts feel too firm for your baby to latch

• Before breastfeeding, to soften the nipple area

• Before pumping, to improve milk flow

Benefits of Reverse Pressure Softening

• Protects your breastfeeding journey: Makes latching possible even during painful engorgement.

• Quick relief: Softens the nipple area within a minute or two.

• Reduces complications: Prevents nipple trauma, blocked ducts, and mastitis.

• Supports supply: Ensures milk is removed effectively, keeping supply in balance.

Other Tips for Managing Engorgement

RPS works best as part of a wider comfort plan:

• Frequent feeding: Aim for 8–12 feeds in 24 hours. Don’t skip feeds.

• Good positioning and latch: Ensure your baby attaches deeply.

• Warmth before feeds: A warm compress or shower can help milk flow.

• Cold after feeds: Cold packs for 10–20 minutes reduce swelling and discomfort (Mangesi & Dowswell, 2010).

• Gentle hand expression: If baby struggles to latch, hand express small amounts for comfort.

• Supportive bra: A well-fitted, non-restrictive bra can help without compressing breast tissue.

When to Seek Help

Contact your midwife, GP, or IBCLC if you notice:

• Severe pain or redness in one area of the breast

• Fever, flu-like symptoms (possible mastitis)

• Nipple cracks or wounds

• Baby struggling to latch despite trying RPS

From Your Midwife’s Heart

Engorgement can feel discouraging, especially when you’ve just begun your breastfeeding journey. Remember: it’s temporary, and there are effective tools to help you through. Reverse pressure softening is one of the simplest, gentlest techniques to make feeding more comfortable and keep your baby well fed.

Every feed is a step forward — and with the right support, engorgement doesn’t have to stand in your way.

References

• Cotterman, K. J. (2004). Reverse pressure softening: A simple tool to prepare areola for easier latching during engorgement. Journal of Human Lactation, 20(2), 227–237.

• Mangesi, L., & Dowswell, T. (2010). Treatments for breast engorgement during lactation. Cochrane Database of Systematic Reviews, (9), CD006946.

• World Health Organization. (2000). Mastitis: Causes and management. WHO.